Abstracts _____________________________________________________ 49 in May 2003. A baseline evaluation was added to the family meal, of which they conducted from April to June 2003 as consume a smaller share. part of the GOI/HKI-NSS Nutrition and Health Surveillance System, and the final Note that an intake of 1.5 mL per adult per evaluation was conducted in the same day is equivalent to one 16-mL sachet per households June to July 2004. The total household every other day (assuming 5 to 6 sample size at baseline was 600 households, household members). The fact that EDTA of which approximately 75% could be enhances the absorption of other iron in revisited one year later. Distribution to a meal may be responsible for part of the warehouses started in May 2003, and from observed effect. the surveys among the neighborhood stores it appears that full market saturation was Recommendations formulated by Dr. de Pee reached in October 2004. Households thus and her colleagues as a result of this study consumed fortified sauce for 6 to 9 months are: before the end of the survey. • For young children, other strategies The consumption of soy sauce was found to reduce anemia, such as in-home to be related to maternal education level, fortification, need to be explored; which is a good indicator of socioeconomic • Another iron-fortified soy sauce status. Those of higher socioeconomic intervention study using different status consumed more soy sauce from dosage levels of NaFeEDTA should bottles. Even among the sachet users, it be done to better understand the appears that those of lower socioeconomic observed impact of this low dosage; status consumed less soy sauce than those from higher strata. • Where the prevalence or risk of anemia among older children Comparison of anemia levels at baseline and adults is high, there should and at follow-up showed that among be a carefully controlled and mothers who consumed 1.5 mL or more rigorously monitored expansion of of soy sauce from sachets per day, anemia the fortification of soy sauce with prevalence dropped from 36% to 20% (p NaFeEDTA. < 0.05). Among the other groups that consumed less or no soy sauce from sachets, Baobab Fruit Pulp (Adansonia anemia prevalence remained stable at 10% digitata L.) Improves Iron Status in to 25%. It was also found that the mothers Nigerian Children who consumed at least 1.5 mL of soy sauce from sachets per day had the highest Dr. Ngozika Nnam, of the University of prevalence of anemia at baseline and were Nigeria, in Nsukka, Nigeria presented a therefore most in need of fortification. It study to show how the baobab fruit can be was found that the sachets were preferred used to improve iron status in Nigerian by the poorer segments of the population children (Th90). In some regions of Nigeria, who are most in need of iron fortification iron deficiency anemia rates in children because of the higher anemia prevalence. are as high as 50%. About 90% of the total dietary supply of iron in Nigeria comes While an impact was found among from plants, which contain non-heme iron mothers, no impact was found among that is poorly absorbed. There is a need children aged 12 to 59 months at baseline, for an intervention program in Nigeria which may be for two reasons. First of promoting locally available foods within all, anemia prevalence among children the reach of the communities to enhance decreased considerably over the follow-up bioavailability of dietary iron. period, which makes it less likely that a small additional effect of the fortified soy Baobab (Adansonia digitata L.) is a tree sauce could be detected. In addition, the plant belonging to the family bombacaceae. consumption of soy sauce among children The tree produces numerous fruits varying is lower than among adults because it is from ovoid to oblong and irregular in length

40 2004 INACG SYMPOSIUM

(up to 40 cm long in West Africa). The fruit The significant increase in hemoglobinis composed of a woody, very hard outer of the children from 10.85 to 12.92 g/dLpart (epicarp) and an inner part (endocarp), was indicative of improved iron status duewhich constitutes the pulp of the fruit. most likely to the added BFPD in the diet.When ripe, the inside of the fruit is dry BFPD is high in ascorbate, which promotesand floury with numerous seeds embedded absorption of iron, possibly by chelation orin the pulp, which has a whitish, powdery by reducing the iron to the ferrous state.appearance. The fruit pulp is rich in The slight increase in mean hemoglobinascorbate, containing 337 mg of vitamin C of the control group was probably dueper 100 g of pulp (about six times the level to improved dietary habits during thein citrus fruit). The pulp is used to prepare experimental period.a drink that is consumed either cold or hotor added to cereal porridges. The fruit is The decrease in the prevalence of childrenlocally available in rural communities in with serum ferritin below 12 µg/L (65% toNigeria. 23%) showed that there was a significant improvement in the iron status of theThe objective of the study was to determine children during the intervention withthe effect of baobab leaf pulp on iron status BFPD.in children using hemoglobin concentrationand serum ferritin level as indicators. Three In conclusion, Dr. Nnam stated thathundred schoolchildren 6 to 8 years of baobab fruit is an inexpensive, natural,age were drawn by sampling from a rural and nutritious source of vitamin C, whichcommunity primary school and screened could be used to improve the iron statusfor the study; 142 children with hemoglobin of children. The fruit pulp is locallylevels less than 11 g/dL were selected. available in rural communities and could beThe children stayed in a metabolic unit incorporated into many dishes to diversifyat the University of Nigeria’s Department and improve the bioavailability of iron.of Home Science and Nutrition for theduration of the study. The 142 children A study conducted in Indonesia towere de-wormed and divided into equal investigate the effectiveness of consuminggroups of 71 children each. One group acceptable and affordable locally availableserved as the control. The hemoglobin meals rich in iron, especially heme-iron,levels of each group were comparable. The from natural foods in improving the irontest group was fed 250 mL of baobab fruit status of adolescent girls had a similarpulp drink (BFPD), which provided 60 mg outcome as that of Dr. Nnam (Th30).ascorbate per day after a cereal/legume/ The conclusion was that foods naturallyvegetable-based meal for 3 months. The rich in iron can contribute to reducing theother group was fed the meal only. The prevalence of anemia among adolescenthemoglobin and serum ferritin levels of girls. It increased hemoglobin concentrationboth groups were estimated before and after and reduced the prevalence of anemiathe intervention period. significantly.

In reporting the results of the study, Dr. Integrated Programming, Including

Nnam indicated that the intervention Home-Based Fortification Usinggroup had a mean hemoglobin of 10.85g/dL (control group mean = 10.86 g/dL) “Sprinkles” is an Effectiveat baseline and 65% had serum ferritin Strategy for Addressing Anemia inbelow 12 µg/L (control group = 68%). Mongolian ChildrenAfter 3 months of intervention with BFPD,the mean hemoglobin of the test group Dr. Solongo Altangerel, of World Visionincreased to 12.92 g/dL and 23% had serum International, in Ulaanbaatar, Mongolia,ferritin below 12 µg/L. The control group opened her presentation by introducinghad only a slight increase in hemoglobin the geographical and population landscape(10.86 to 11.01 g/dL) and no change in of Mongolia (Th91). In this landlockedserum ferritin. country of 2.5 million inhabitants, the

2004 INACG SYMPOSIUM 41

Report of the 2004 International nutritional Anemia consultative group symposium

iron deficiency in early life: challenges and progress lima, peru 18 november 2004